Healthcare Provider Details

I. General information

NPI: 1407785678
Provider Name (Legal Business Name): ASHA AUTUMN EVE BOGGS MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 UNIVERSITY AVE W
SAINT PAUL MN
55104-3426
US

IV. Provider business mailing address

1348 COLLEEN AVE
ARDEN HILLS MN
55112-1934
US

V. Phone/Fax

Practice location:
  • Phone: 612-289-5656
  • Fax: 651-925-0534
Mailing address:
  • Phone: 612-289-5656
  • Fax: 651-925-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32957
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: